As determined by the Health Ministry, although CVDs are commonly associated with adulthood, the lesser-known fact is that children too are at risk of developing CVD, notes consultant pediatrician and pediatric cardiologist Dr Choo Kok Kuan.

The most common heart disease among children is known as congenital heart defects (CHD); the incidence of CHD among children is about eight to 10 per 1,000 live births.

With an average of 500,000 deliveries in Malaysia each year, the number of children born with CHD is about 5,000 a year, of which two-thirds will require surgical intervention. 

CHDs occur when the heart or blood vessels near the heart do not develop normally before birth.

Most CHDs have no known cause. They may sometimes run in families. Some may be associated with genetic disorders such as Down syndrome, Turner syndrome and Williams syndrome.

Some children are predisposed to CHDs if the mother has diabetes or rubella or has taken certain medications (such as anti-epileptic drugs) during pregnancy.

Sometimes a heart defect can be diagnosed before a baby is born. However, defects are usually identified days or even months after birth when symptoms become obvious.

Less serious CHDs may not be diagnosed until later in childhood because there may not be any noticeable signs and symptoms.

It is also possible to have a heart defect and show no symptoms at all.

“Critical role of doctors”

Every child deserves a healthy heart. Doctors play a critical role in identifying any potential issues if the newborn baby is “not doing well” and having a high index of suspicion to be able to rule out a serious congenital cardiac problem that needs early intervention.

Parents and caregivers of newborns and very young children should also be aware of CHDs to improve on early detection and management of the disease.

Some of the most commons symptoms of serious CHDs to watch out for include:

• Rapid breathing
• Bluish discoloration of the skin and mucous membranes around the lips, fingernails, palms of the hands and soles of the feet (i.e. cyanosis)
• Shortness of breath during feeding, leading to poor weight gain
• Poor growth
• Recurrent lung infection

As a result of medical advancements, the outlook for CHDs is increasingly positive. Children with CHDs can survive and live into adulthood, depending on the type of birth defect.

However, parents are faced with challenges that come with caring for children with CHDs who have unique and special needs. For instance:

• Heart medicines can be very strong and dangerous if not given correctly. Parents must understand how much medicine to give and how to give it. And if the child takes a blood thinner, parents must have clear instructions on how to give this medicine safely.
• Parents must ensure the child eats well and receives adequate nutrition; children with CHDs often tire when eating so they eat less and may not get enough calories.
• Preventing infections is crucial. Although infection in the heart or endocarditis is uncommon, children with heart defects have a greater risk of developing this. Good dental hygiene goes a long way toward preventing endocarditis by reducing the risk of tooth or gum infection. Parents can get more information from cardiologists about the latest guidelines on antimicrobial prophylaxis against infective endocarditis. These children must also get all the recommended vaccinations.
• Most children with congenital heart defects can be physically active without restrictions. In fact, children are encouraged to be physically active to keep their hearts fit and to avoid obesity (unless they have a few specific heart conditions).
• Emotional support will help children who may have self-esteem issues because of how they look. They may have scars from surgery, be smaller or have limits on how active they can be.
• As these children transition to adulthood, parents can gradually teach them about their heart defects and guide them in how to care for their own health without being overly protective.

“Mild heart defects don’t need treatment”

Despite the typical reaction to CHDs, parents should be aware that some mild heart defects do not require any treatment.

And although the more complex heart defects need medication, interventional procedures or surgery, many heart defects can be successfully managed often in early infancy.

Most children with CHDs reach adulthood. In fact, children with simple conditions may lead completely normal lives, while those with more complex conditions usually face more challenges that can nevertheless be surmounted with the right measures in place.

The goal is to prevent complications, reduce the morbidity and mortality associated with heart defects, optimise and improve the quality of the lives of children with congenital heart disease.

Furthermore, the most common congenital heart disease is a hole in the heart known as septal defects, says consultant cardiothoracic surgeon Dr Kenny Cheng.

There are different types of septal defects depending on location and complexity such as atrial septal defects (ASD), ventricular septal defects (VSD) or AV septal defects (AVSD).

CHDs are conventionally treated by corrective surgery but certain septal defects can be closed with an occlusion device.

Although congenital heart disease may pose significant challenges for the family, most cases are treatable with today’s medical breakthroughs. Any symptoms are manageable with proper medication and frequent consultation by professional healthcare practitioners.